Successful management of clostridium difficile colitis with antegrade Vancomycin through a mu-cous fistula eliminating the need for subtotal colectomy

Clostridium difficile (CD) is the most common cause of healthcare-associated infections and can have devastating morbidity and mortality. A 40-year-old diabetic patient who was recently treated for wound sepsis, subsequently developed CD colitis. This patient failed the standard medical therapy for CD colitis, decompensated and required surgical exploration, partial colectomy and mucous fistula creation. Following surgery, her clinical condition improved and her colitis resolved with the antegrade administration of vancomycin through mucous fistula. Traditional treatment algorithms involve oral metronidazole or vancomycin. Our case study report describes the index case of topical vancomycin through a mucous fistula may have reduced the need for total colectomy in the treatment of fulminant CD colitis.